Reinventing Care: Assisted Living in New York City

5. Market-Driven Private-Pay Assisted Living

98 5 Market-Driven Private-Pay Assisted Living The organization of health and social services in the United States changed in the twentieth century. In 1900, hospitals, county homes, and other institutions cared almost exclusively for the indigent. Nursing students, as a part of their training, provided much of the direct care. Most nurses left these institutions after graduation to serve as private-duty nurses in the homes of families that needed and could afford their services. Most of a physician’s private practice involved making house calls and caring for patients in their own homes. As medical advances progressed, hospitals became the preferred site of care, not the last resort of the destitute . This shift culminated with the integration of private-pay and indigent patients after the implementation of Medicare and Medicaid. The emergence of private-market assisted living at the end of the twentieth century began to swing the pendulum back in the opposite direction. This chapter explores the potential implications of this swing through five case studies of facilities that cater to the private-pay market . National for-profit chains operate two of them, two are operated by nonprofits, and one is owner-operated. Two are in urban locations and three in suburban locations. While facilities like these could be located anywhere in the United States, their licensure status reflects the distinctive laws of New York State. Two are licensed as adult homes, one as enriched housing, and two are unlicensed. All five meet the broad definition of assisted living facilities, as they “provide or arrange for assisted living services such as personal care services or help with activities of daily living such as bathing, dressing and toileting” (Nursing Home Community Coalition 2000, 1). I will use the general framework developed in the previous chapter, describing first the business strategy and then the way each has addressed the distinctive demands that assisted living services face. The facilities described in this chapter are identified by the following pseudonyms: Market-Driven Private-Pay Assisted Living 99 1. Harbor View: A licensed private-pay, owner-operated adult home in New York City. 2. Residential Suites: An unlicensed private-pay proprietary facility in New York City, locally owned but operated by an assisted living management company. 3. Suburban Manor: An unlicensed private-pay facility in suburban New York owned and operated by a publicly traded chain. 4. Health Campus Village: A licensed private-pay enriched housing facility in Upstate New York owned and operated as part of a nonprofit hospital-developed integrated delivery system. 5. Shady Oaks: A licensed private-pay, nonprofit adult home in suburban New York. At the end of the chapter I will explore the question of the longerterm impact of the development of exclusively private-pay assisted living such as these five. Harbor View Business Strategy MARKET NICHE Harbor View is a licensed adult home catering to private clientele that, according to its brochure, “offers a luxurious lifestyle in a secure and caring environment.” The facility has almost two hundred residents. It is a family-owned operation that opened about thirty years ago in the midst of the darkening storm of scandals that were to engulf the city’s nursing home industry. The grandfather of the family started the business by opening a nursing home in a tight-knit ethnic community. The business now includes nursing homes as well as this assisted living facility . The facility receives high marks from state regulators. It has a solid reputation in the community. Among peers in the business, it has a reputation for innovation in providing high-quality care for the frail elderly. The family member who currently serves as the administrator handles the day-to-day operations with humor, energy, and insight. There is little turnover of employees, and all seem enveloped in a large extended family that extends to the residents and their families. The location offers residents stunning views, which give the impression of a resort hotel. Careful monitoring of operating margins and an elegant adaptation to private and public sources of income for this business result in a prof- 100 Reinventing Care itable operation. The facility will not accept or keep residents who cannot pay its private rates. They have, however, on occasion, accepted residents whose families have made up the difference between the facility’s rate and the Supplemental Security Income (SSI) rate. The facility recently opened an adult day care center whose...